Evidence-Based Communication Skills Change Processes

Evidenced Based Communication Skills Change Processes And Interventi

Implementing effective change processes and interventions in healthcare settings requires a thorough understanding of theoretical frameworks and evidence-based strategies. This paper explores the application of Lewin’s theory of planned change and the A3 problem-solving method within a clinical practicum. It investigates how these frameworks facilitate communication, stakeholder engagement, and process improvement, aligning with DNP essentials and individual learning objectives.

Lewin’s theory of planned change provides a structured approach to organizational transformation through three distinct phases: unfreezing, moving, and refreezing (Shirey, 2013). The unfreezing phase recognizes a problem, assesses the need for change, and identifies discrepancies between current and desired states. In practice, this involves data analysis and stakeholder recognition of issues such as delays in operating room (OR) first-case starts. The moving phase focuses on designing and executing actionable strategies, engaging frontline staff and leaders in implementing change initiatives. Finally, the refreezing phase solidifies new processes through policies, standardization, and ongoing evaluation, ensuring sustainability of the improvements (Shirey, 2013).

The A3 problem-solving methodology, adapted from Toyota’s manufacturing processes, offers a systematic approach to quality improvement. The A3 tool encompasses categories such as issue identification, background, current conditions, root cause analysis, target conditions, countermeasures, testing, implementation, cost analysis, and follow-up (Bassuk & Washington, 2013). Its structured nature facilitates clear communication among stakeholders and supports the Plan-Do-Study-Act (PDSA) cycle, essential for continuous improvement (Bassuk & Washington, 2013).

During field experiences, these frameworks have demonstrated utility in real-world settings. For instance, in the OR, a nurse manager recognized delayed first-case starts but struggled with data utilization and communication pathways. Applying the A3 method allowed for structured diagnosis, root cause identification, and development of targeted countermeasures. Engaging staff across disciplines fostered horizontal communication, while reporting to leadership enhanced vertical communication, aligning with Schwartz et al.’s (2011) emphasis on accessible leadership and open communication channels as critical factors for organizational effectiveness.

Contrasting this with efforts at the infusion center (IC), where the nurse manager was initially uncertain about the existence of a problem, highlights the importance of tailored data collection and stakeholder engagement. Qualitative interviews and collaborative discussion helped identify external factors influencing patient satisfaction scores, illustrating how horizontal collaboration across multiple units can facilitate comprehensive solutions. These experiences reinforce that effective change is multidimensional, requiring both communication and strategic planning aligned with organizational priorities.

These evidence-based strategies directly support Doctor of Nursing Practice (DNP) Essentials, particularly Essential II: Organizational and Systems Leadership for Quality Improvement and Systems Thinking. By employing structured frameworks like Lewin’s model and A3, nurse leaders can systematically address clinical issues, promote safety, and enhance care quality (AACN, 2006). These approaches also exemplify systems thinking and leadership responsibilities that influence practice-level and system-wide improvements, thus fulfilling DNP curricular expectations and fostering leadership competencies (AACN, 2006).

Comparison with previous practicum experiences reveals increased engagement and autonomy among nurse managers. Personalized collaboration fosters a deeper understanding of change processes and strengthens leadership development. The preceptor’s supportive yet autonomous role enhances capacity-building in leaders, preparing them for future improvement initiatives (Shirey, 2013). These insights underscore the significance of strategic communication, stakeholder involvement, and tailored interventions in driving sustainable healthcare improvements.

References

  • American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice. Retrieved from https://www.aacn.nche.edu/publications/position/doe.pdf
  • Bassuk, J. A., & Washington, I. M. (2013). The A3 problem solving report: A 10-step scientific method to execute performance improvements in an academic research vivarium. PLoS ONE, 8(10), e78273. https://doi.org/10.1371/journal.pone.0078273
  • Schwartz, D. B., Spencer, T., Wilson, B., & Wood, K. (2011). Transformational leadership: Implications for nursing leaders in facilities seeking magnet designation. AORN Journal, 93(6), 615–626. https://doi.org/10.1016/j.aorn.2010.09.032
  • Shirey, M. R. (2013). Lewin’s theory of planned change as a strategic resource. Journal of Nursing Administration, 43(2), 69–72. https://doi.org/10.1097/NNA.0b013e31827f20a7
  • Tanner, C., Gans, D., White, J., Nath, R., & Pohl, J. (2015). Electronic health records and patient safety: Co-occurrence of early EHR implementation with patient safety practices in primary care settings. Applied Clinical Informatics, 6(1), 136–147. https://doi.org/10.4338/ACI-2014-07-RA-0088
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